Coronary CT angiography for the detection of coronary artery stenosis in patients referred fortranscatheter aortic valve replacement

Ashraf Hamdan, Ernst Wellnhofer, Eli Konen, Sebastian Kelle, Orly Goitein, Bogdan Andrada, Ehud Raanani, Amit Segev, Israel Barbash, Robert Klempfner, Ilan Goldenberg, Victor Guetta

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Coronary CT has become the foremost noninvasive imaging modality for detecting coronary stenoses in patients with suspected coronary artery disease. Nevertheless, little is known about its performance in patients undergoing transcatheter aortic valve replacement (TAVR). Objective: This study investigates the diagnostic performance of coronary CT angiography in patients referred for TAVR. Methods: One hundred and fifteen consecutive patients with severe aortic stenosis underwent CT angiography with retrospective electrocardiography triggered acquisition and an iterative reconstruction algorithm, of whom 23 (20%) had prior coronary artery bypass graft (CABG) surgery. Diagnostic accuracy of CT for detecting significant coronary stenosis (≥50% luminal diameter stenosis in segments ≥2mm) in the left main, proximal, or middle segments of coronary arteries and bypass grafts was compared with that of invasive coronary angiography. Results: In the overall study population, the sensitivity, specificity, and positive and negative predictive value of CT angiography for the detection of coronary segment or bypass graft lesions were 96% (47 of 49), 73% (48 of 66), 72% (47 of 65), and 96% (48 of 50), respectively. The per-patient diagnostic yield of CT angiography was consistent among patients without prior CABG (93% [28 of 30], 73% [45 of 62], 62% [28 of 45], and 96% [45 of 47], respectively) and among patients with prior CABG (100% [19 of 19], 75% [3 of 4], 95% [19 of 20], and 100% [3 of 3], respectively). Conclusion: Among patients referred for TAVR, coronary CT angiography with retrospective gating and iterative reconstruction may allow detection of significant stenosis in the proximal or middle segments of coronary arteries and could permit the evaluation of patients after bypass grafts.

Original languageEnglish
Pages (from-to)31-41
Number of pages11
JournalJournal of Cardiovascular Computed Tomography
Volume9
Issue number1
DOIs
StatePublished - 1 Jan 2015

Keywords

  • Coronary CT angiography
  • Diagnostic performance
  • TAVR

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